title: Reducing the length of stay for acute hospital patients needing admission into inpatient rehabilitation: a multicentre study of process barriers.
abstract: BACKGROUND
  Patient flow is a major problem in hospitals. Delays in accessing inpatient rehabilitation have not been well studied.
  
  
  OBJECTIVE
  Measure the time taken for key processes in the patient journey from acute hospital admission through to inpatient rehabilitation admission in order to identify opportunities for improvement.
  
  
  METHODS
  Retrospective open cohort study. All patients admitted over 8- and 10-month periods during 2008 into two inpatient rehabilitation units in Melbourne, Australia. Main outcome measures were the duration of the following key processes: acute hospital admission until referral for rehabilitation, referral until assessment by the rehabilitation service, assessment until deemed ready for transfer to rehabilitation, ready for transfer until rehabilitation admission.
  
  
  RESULTS
  Three hundred and sixty patients were in the study sample (females = 186; 51.7%); mean age = 58.4 (standard deviation = 15.0) years. There was a median of 7 (interquartile range [IQR] 4-13) days from acute hospital admission till referral for rehabilitation, a median of 1 (IQR 0-1) day from referral till assessment, a median of 0 (IQR 0-2) days from assessment till deemed ready for transfer and a median of 1 (IQR 0-3) day from ready till admission into rehabilitation. Overall, patients spent 12.0% (804/6682) of their acute hospital admission waiting for a rehabilitation bed.
  
  
  CONCLUSIONS
  There are opportunities to improve the efficiency of key processes in the acute hospital journey for patients subsequently admitted to inpatient rehabilitation; in particular, reducing the time from acute hospital admission till referral for rehabilitation and from being deemed ready for transfer to rehabilitation till admission.
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. peter.new@monashhealth.org
authors.forename: P W
authors.initials: PW
authors.lastname: New
authors.forename: N
authors.initials: N
authors.lastname: Andrianopoulos
authors.forename: P A
authors.initials: PA
authors.lastname: Cameron
authors.forename: J H
authors.initials: JH
authors.lastname: Olver
authors.forename: J U
authors.initials: JU
authors.lastname: Stoelwinder
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization / Q000639:trends; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000592:standards* / Q000639:trends; D010360:Patient Transfer / Q000592:standards* / Q000639:trends; D017064:Process Assessment, Health Care / Q000592:standards* / Q000639:trends; D012017:Referral and Consultation / Q000592:standards* / Q000639:trends; D012047:Rehabilitation Centers / Q000592:standards*; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
keywords: delivery of healthcare; health service accessibility; outcome and process assessment (healthcare); patient discharge; rehabilitation